Better Solutions for Healthcare

AXIOS: 1 big thing: Congress eyes hospital “dishonest billing”

We’ve written before that there’s a growing target on hospitals’ backs now that pharma took its beating in the IRA. Now, Peter reports that a particular hospital-focused issue is gaining Congress’s attention: what critics dub “dishonest billing.”

Between the lines: The phrase refers to when hospitals buy doctors’ offices and then charge higher hospital rates for the exact same service delivered in those offices.

  •       The issue is closely related to the long-running push for “site-neutral payments,” the idea that Medicare should pay the same amount for the same service regardless of where it’s performed.

Driving the news: Lobbyists and aides told Axios of increasing activity in Congress on these fronts:

  •       Rep. Annie Kuster plans to cosponsor a bill by Rep. Victoria Spartz addressing the issue when it is reintroduced this Congress, Kuster’s office said, lending bipartisan support to the measure.
  •       The bill would require doctors’ offices owned by hospitals to have unique codes used in billing so that payers can know the care is not being done in a hospital and help them pay a lower amount.
  •       Sens. Mike Braun, Maggie Hassan and Tammy Baldwin are among the senators discussing bipartisan legislation on the issue, though there is no bill yet.

What they’re saying: “It’s the next big fight in terms of addressing affordability coming off the heels of the passage of the IRA, the ban on surprise medical bills,” said Sophia Tripoli, who works on the issue for the health care consumer group Families USA.

  •       “So we certainly are pushing very, very hard in Congress for a site-neutral payment policy solution to get over the finish line. I think there’s a lot of bipartisan energy.”
  •       She noted that Families USA is working with employers and labor unions to press for action.

Yes, but: There are also significant hurdles, including opposition from hospitals, which are a powerful force in the local communities that members represent.

  •       Hospitals argue they need to charge prices that enable them to cover their higher costs. “The cost of care delivered in hospitals and health systems takes into account the unique benefits that only they provide to their communities,” said Ashley Thompson, a senior vice president at the American Hospital Association.
  •       “Hospital investments in the range of providers along the continuum of care can also increase access for patients and communities,” she added.
  •       The political environment, where Democrats are attacking Republicans for wanting to cut Medicare, also makes any bipartisan action on changes to the program tough, even if it is not cutting benefits for seniors.

The other side: Rep. Larry Bucshon said the issue has been a point of discussion in the GOP Doctors Caucus and that he disagrees with hospitals’ argument.

  •       “They say that they have all these overhead costs, that if this was changed, it would make it difficult,” he told Axios. “I would beg to differ. I don’t think that’s true. I think that they just make more money, getting paid more for the same procedure as a physician office does.”
  •       But in a blunt acknowledgement of the political realities, when asked if “hospitals are powerful enough, their lobbying is good enough that Congress can’t address this,” Bucshon replied: “The short answer is yes.”